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Resumen Cuando hablamos de bypass gástrico, en realidad nos referimos a un conglomerado de técnicas que tienen en común la creación de un reservorio gástrico de pequeño tamaño sobre el cual se realiza una anastomosis gastroyeyunal en "Y" de Roux. La diversidad de métodos por los que esto se consigue hace que los resultados globales de la técnica no puedan ser extrapolados, de forma inequívoca, a todos los pacientes con obesidad mórbida. El objetivo de este artículo es revisar los resultados con aquellas variaciones que tienen más importancia, la creación de la anastomosis gastroyeyunal y la longitud de los distintos tramos intestinales que se crean, así como evaluar cual es el papel que ocupa el bypass gástrico actualmente en el arsenal de técnicas de las que disponemos en el tratamiento quirúrgico de la obesidad mórbida.

We study the large class of solvable lattice models, based on the data of conformal field theory. These models are constructed from any conformal field theory. We consider the lattice models based on affine algebras described by Jimbo et al., for the algebras $ABCD$ and by Kuniba et al. for $G_2$. We find a general formula for the crossing multipliers of these models. It is shown that these crossing multipliers are also given by the principally specialized characters of the model in question. Therefore we conjecture that the crossing multipliers in this large class of solvable interaction round the face lattice models are given by the characters of the conformal field theory on which they are based. We use this result to study the local state probabilities of these models and show that they are given by the branching rule, in regime III., Comment: 17 pages, no figures. Major revision. Added an appendix for the proof for WZW models of the character formula

Objetivo El Análisis de Situación de Salud (ASIS) es una metodología que se encuentra en implementación recientemente en Colombia. Este estudio buscó comprender la experiencia de construcción, divulgación y uso del ASIS para la toma de decisiones en algunas entidades territoriales (ET).Métodos Entrevistas semiestructuradas a funcionarios de las entidades departamentales de salud; la información fue analizada de acuerdo a un conjunto de categorías establecidas previamente.Resultados Las ET implementan el ASIS incorporando el enfoque de los Determinantes Sociales de la Salud; sin embargo, las capacidades técnicas, económicas y humanas son desiguales para la elaboración de este tipo de análisis; la participación intersectorial y social aún es débil y los resultados generados todavía no orientan latoma de decisiones a nivel territorial.Conclusiones La metodología ASIS aspira a posicionarse como uno de los mecanismos oficiales para generar evidencia que oriente las políticas y la toma de decisiones en salud a nivel nacional, regional y local; existen desafíos a nivel económico, institucional y político para su consolidación como estrategia de útil en la planificación en salud. El ASIS es una metodología de gran relevancia para las ET y debe seguir fortaleciéndose su implementación.

ResumenObjetivoCaracterizar cinemáticamente el gesto técnico del remate en voleibol en un grupo de jugadoras experimentadas de categoría sénior utilizando un sistema de captura y análisis del movimiento tridimensionalmente.MétodoSe utilizó un sistema de captura de movimiento con cinco cámaras de alta velocidad (100Hz). Se definió un modelo de marcadores de 27 marcas reflectantes.ResultadosSe analizaron 38 parámetros cinemáticos, entre ellos: tiempos entre eventos, posición del centro de masas, velocidades y altura del remate. Se describieron parámetros como tiempo de vuelo, velocidad de impulsión vertical, salida del balón y rango de movimientos en brazo ejecutor, entre otros, con valores cercanos a los publicados por otros autores.ConclusionesEl presente estudio ha permitido definir un protocolo y modelo de informe como herramienta para el entrenamiento personalizado en función de las deficiencias observadas y para prevenir posibles lesiones a medio/largo plazo.AbstractObjectiveCharacterize the kinematic parameters in a group of experienced women senior class volleyball players using a 3D motion capture and analysis system.MethodA motion capture system connected to five high-speed cameras (100Hz) was used. A marker set was defined using 27 reflective marks.ResultsThirty eight kinematic parameters were analyzed: time between events, centre of mass, speed, height of spike. Many parameters were described as flight time, vertical impulsion speed, ball speed after spiking and range of movement in executor arm, among others, with similar values to those published by other authors.ConclusionsThis study has defined a protocol and a custom report as tool for personalized training according to deficiencies detected and to prevent injuries at medium/long term.

Identification and quantification of the separate roles of compression and of cake build-up in membranes under different fouling conditions can provide a better understanding of filtration and MBR behavior. A simple and rapid flux-step method for evaluation of critical flux, subcritical and supracritical fouling rates and in situ determination of internal and external irreversible fouling resistance and compressibility, without provoking alteration of the system and without stopping the treatment process is proposed. The main novelty of the modified method is the inclusion of a new stage, termed pre-compression, by means of a flux increase at the beginning of each filtration step. The incorporation of pre-compression phases suppresses the time dependent compression of the irreversible fouling that interferes with the accurate determination of fouling rate, even in highly compressible fouled membranes. Hysteresis tests confirmed that extra fouling due to the pre-compression stages is reversible. The compressibility index of external irreversible fouling rose as high as 0.59, pore blocking compressibility was significantly small and reversible fouling compression effect was not observed in short-term test. A novel method was employed to determine the scouring effect and to measure the efficiency of in situ chemical cleaning methods applied to an AnMBR.

Los huesos sesamoideos se desarrollan en el espesor de ciertos tendones o de la cápsula fibrosa que envuelve ciertas articulaciones. La prevalencia y distribución de los huesos sesamoideos en la mano es variable entre diferentes grupos poblacionales y étnicos. Basados en esta premisa realizamos un estudio para determinar su presencia en las diferentes articulaciones metacarpo-falángicas (AMF) de dos grupos de individuos. Analizamos 34 radiografías de manos de adultos, chilenos, de ambos sexos, así como 19 radiografías pertenecientes a manos de niños y adolescentes. También se estudiaron 41 radiografías de manos de adultos, Brasileños, de ambos sexos, así como 16 radiografías de niños y adolescentes. En cada observación consideramos el número de huesos sesamoideos y su localización. En el grupo de individuos chilenos se observó la presencia de dos huesos sesamoideos, radial y ulnar, localizados a nivel de la AMF del pulgar en 94,1% de los casos; 44,1% tenían un hueso sesamoideo a nivel de la parte radial de la AMF del dedo indicador. A nivel de la AMF del dedo mínimo, se observó un hueso sesamoideo en 11,8%. Del análisis de 19 radiografías de manos de niños y adolescentes, se visualizó 42% con huesos sesamoideos a nivel de la AMF del pulgar. En el grupo de individuos brasileños, se observó que todas las manos tenían huesos sesamoideos a nivel de la AMF del pulgar; 90,2% tenían dos huesos. En 17,1% se encontró un hueso sesamoideo a nivel de la parte ulnar de la articulación interfalángica del pulgar. En 26,8% se observó un hueso sesamoideo en la parte radial de la AMF del indicador y en el mismo porcentaje a nivel de la parte radial de la AMF del dedo mínimo. De las 16 radiografías de manos de niños y jóvenes brasileños, ninguna de ellas presentó tales huesos. Los datos aportados dejan en evidencia las diferencias que existen entre grupos poblacionales y étnicos.

The Health Situation Analysis (ASIS in Spanish) is a methodology that has been implemented recently in Colombia. This study aims at understanding the experience of building, disseminating and using ASIS for decision-making in some territorial entities.Semistructured interviews were applied to officials of the departmental health entities. The information was analyzed according to a set of categories previously established.The territorial entities implement ASIS by incorporating the Social Determinants of Health approach; however, the technical, economic and human capacities for the elaboration of this type of analysis are not equitable. Intersectoral and social participation is still weak and the results do not guide the decision making at territorial level yet.The ASIS methodology seeks to position itself as one of the official mechanisms to generate evidence that guides health policy and decision making at national, regional and local levels. There are economic, institutional and political challenges for its consolidation as a useful strategy in health planning. ASIS is a methodology of great relevance for the territorial entities and its implementation should be further strengthened.El Análisis de Situación de Salud (ASIS) es una metodología que se encuentra en implementación recientemente en Colombia. Este estudio buscó comprender la experiencia de construcción, divulgación y uso del ASIS para la toma de decisiones en algunas entidades territoriales (ET).Entrevistas semiestructuradas a funcionarios de las entidades departamentales de salud; la información fue analizada de acuerdo a un conjunto de categorías establecidas previamente.Las ET implementan el ASIS incorporando el enfoque de los Determinantes Sociales de la Salud; sin embargo, las capacidades técnicas, económicas y humanas son desiguales para la elaboración de este tipo de análisis; la participación intersectorial y social aún es débil y los resultados generados todavía no orientan la toma de decisiones a nivel territorial.La metodología ASIS aspira a posicionarse como uno de los mecanismos oficiales para generar evidencia que oriente las políticas y la toma de decisiones en salud a nivel nacional, regional y local; existen desafíos a nivel económico, institucional y político para su consolidación como estrategia de útil en la planificación en salud. El ASIS es una metodología de gran relevancia para las ET y debe seguir fortaleciéndose su implementación.

Diabet. Med. 27, 1178–1187 (2010) Abstract Aims Beradinelli–Seip congenital generalized lipodystrophy is a rare autosomal recessive disorder characterized by near-complete absence of adipose tissue, Herculean appearance, insulin resistance, hypoleptinaemia and diabetes mellitus. The aim of this study was to investigate the in vitro effects of pioglitazone on the expression of genes involved in adipogenesis in fibroblasts from a patient with this condition due to a seipin mutation. Methods Primary cultures of fibroblasts from the skin of the patient were obtained. Fibroblasts were treated with classic adipose differentiation medium, with and without pioglitazone. Several adipogenes were evaluated by real-time reverse transcriptase-polymerase chain reaction and western blotting. Intracellular localization of prelamin A was studied by immunofluorescence microscopy. Results The expression of the adipogenic genes PPARG, LPL, LEP and SLC2A4 was reduced in lipodystrophic fibroblasts, while treatment with pioglitazone increased the expression of these genes. Moreover, and unexpectedly, we found an accumulation of farnesylated prelamin A in lipodystrophic fibroblasts. Conclusions The process of adipocyte differentiation is compromised in patients with Beradinelli-Seip congenital lipodystrophy owing to diminished expression of the regulatory genes involved, which pioglitazone treatment partially rescues. Prelamin A accumulation establishes a link with other types of familial lipodystrophies, as familial partial lipodystrophy.

We obtain an approximate global stationary and axisymmetric solution of Einstein's equations which can be considered as a simple star model: a self-gravitating perfect fluid ball with constant mass density rotating in rigid motion. Using the post-Minkowskian formalism (weak-field approximation) and considering rotation as a perturbation (slow-rotation approximation), we find approximate interior and exterior (asymptotically flat) solutions to this problem in harmonic and quo-harmonic coordinates. In both cases, interior and exterior solutions are matched, in the sense of Lichnerowicz, on the surface of zero pressure to obtain a global solution. The resulting metric depends on three arbitrary constants: mass density, rotational velocity and the star radius at the non-rotation limit. The mass, angular momentum, quadrupole moment and other constants of the exterior metric are determined by these three parameters. It is easy to show that this type of fluid cannot be a source of the Kerr metric

Completion with anchored guns instead of killing techniques have been used extensively in Ecuador since 2008, completing 111 works to date only in Block 15. During this process several continuous improvement practices as well as new completion techniques were implemented including: Job design improvements: Well integrity analysisPenetration and Flow profile analysis on a foot by foot basisOptimization of the current designs by comparing dynamic under/over balance pressure recording with the simulation resultsPost audit of the calculated vs actual productivity Operational improvements: No fluid loss control used in workover operationsUp to two days of early production due to control fluid does not go into formation.Cost reduction since no special control fluid is used when perforating with static/dynamic underbalance and anchored guns.Minimal fluid loss control when perforating with anchored guns (small overbalanced perforating).New dual concentric completion architecture with anchored guns on the lower sands.The use of anchored guns in reentry wells with 5 ½" casing.Rig time saving when running anchored guns in monobore completionNew perforating procedure in monobore completion by activating anchored guns when ESP is running in hole, then pump is placed to the designed depth, this new operational sequence helped to prevent ESP damage due to high pressure is needed to activate firing head during workover operations when a low pressure reservoir is perforated. Productivity improvements: Significant reduction in both perforating and completion skins using static and dynamic underbalance. This paper shows different case studies of completion and perforating designs that enabled to reduce skin as well as completion time in Block 15. A new completion procedure using anchored guns with dual concentric completion is also described.

Multivariate techniques have been applied to the set of data obtained after one year sampling of volatile organic compounds (VOCs), including volatile aldehydes in the area of Madrid in order to evaluate the possible correspondence among groups of analysed compounds, as far as modelling of different emission sources in relation to location and season. The measurements were carried out at four sites in Madrid, characteristic for urban and suburban areas. Additionally, as reference, a rural area 100 km far from the city was considered. Results of correlation analysis, factor and cluster analysis are presented. Higher correlations were found between variables related with traffic emissions. Factor analysis results showed two main significant variables related to anthropogenic and biogenic emissions respectively. In relation to cluster analysis, samples were grouped according to sampling site and seasonal variations.

Variaciones en el origen de los ramos del plexo lumbar son observadas comúnmente durante las disecciones. Entre ellas se pueden mencionar: ausencia del nervio iliohipogástrico, presencia de un nervio obturador accesorio, bifurcación del nervio femoral, entre otras, destacándose la presencia de un nervio accesorio del nervio femoral. Durante una disección de rutina, en un cadáver fijado en formaldehido 10%, de un individuo adulto, Chileno, de sexo masculino, se observó la presencia unilateral de este nervio femoral accesorio originado del ramo anterior del nervio femoral, el cual estaba formado por dos ramos, describiendo sus características de origen, trayecto y distribución. Las variaciones anatómicas del plexo lumbar deben ser consideradas en el momento de efectuar cirugías en la región, evitando daños al nervio mencionado u otros, durante la disección quirúrgica. Variations in the origin of the branches of the lumbar plexus are commonly observed during dissections. Among them may be mentioned: absence of iliohypogastric nerve, the presence of an accessory obturator nerve, femoral nerve bifurcation, highlighting the presence of a accessory femoral nerve. During routine dissection in a cadaver fixed in 10% formaldehyde, an adult individual, Chilean, male, unilateral accessory femoral nerve was observed, originating from the anterior branch of femoral nerve, which consisted of two branches.The characteristics of origin, course and distribution are described. Anatomical variations of the lumbar plexus must always be considered at the time of surgery in the mentioned sector avoiding nerve damage, during surgical dissection.

El nervio isquiatico nace del plexo sacro y sale de la pelvis a traves del foramen isquiatico mayor por debajo del musculo piriforme como un tronco comun. En ocasiones, este nervio puede emerger dividido en sus dos componentes: el nervio fibular comun y nervio tibial, encontrandose, variaciones que podrian dar origen a una condicion de compresion nerviosa. En este trabajo se exponen dos variaciones del nervio isquiatico en un mismo individuo, donde en la primera el nervio fibular comun atraviesa el musculo piriforme y luego desciende junto al nervio tibial y la segunda, donde el nervio fibular comun se forma a partir de un ramo superior que perfora el musculo piriforme y el otro inferior que pasa debajo de el, para unirse luego en el margen inferior de este musculo y formar el nervio fibular comun, que desciende junto al nervio tibial. Las variaciones del nervio isquiatico en relacion al musculo piriforme podrian explicar el sindrome del musculo piriforme.

Beradinelli-Seip congenital generalized lipodystrophy is a rare autosomal recessive disorder characterized by near-complete absence of adipose tissue, Herculean appearance, insulin resistance, hypoleptinaemia and diabetes mellitus. The aim of this study was to investigate the in vitro effects of pioglitazone on the expression of genes involved in adipogenesis in fibroblasts from a patient with this condition due to a seipin mutation.Primary cultures of fibroblasts from the skin of the patient were obtained. Fibroblasts were treated with classic adipose differentiation medium, with and without pioglitazone. Several adipogenes were evaluated by real-time reverse transcriptase-polymerase chain reaction and western blotting. Intracellular localization of prelamin A was studied by immunofluorescence microscopy.The expression of the adipogenic genes PPARG, LPL, LEP and SLC2A4 was reduced in lipodystrophic fibroblasts, while treatment with pioglitazone increased the expression of these genes. Moreover, and unexpectedly, we found an accumulation of farnesylated prelamin A in lipodystrophic fibroblasts.The process of adipocyte differentiation is compromised in patients with Beradinelli-Seip congenital lipodystrophy owing to diminished expression of the regulatory genes involved, which pioglitazone treatment partially rescues. Prelamin A accumulation establishes a link with other types of familial lipodystrophies, as familial partial lipodystrophy.

ObjectiveToxic thyroid adenoma (TA) is a common cause of hyperthyroidism. Mutations in the TSH receptor (TSHR) gene, and less frequently in the adenylate cyclase-stimulating G alpha protein (GNAS) gene, are well established causes of TA in Europe. However, genetic causes of TA remain unknown in a small percentage of cases. We report the first study to investigate mutations in TSHR, GNAS, protein kinase, cAMP-dependent, regulatory, type I alpha (PRKAR1A) and RAS genes, in a large series of TA from Galicia, an iodine-deficient region in NW Spain.Design and methodsEighty-five TA samples were obtained surgically from 77 hyperthyroid patients, operated on for treatment of non-autoimmune toxic nodular goitre. After DNA extraction, all coding exons of TSHR, GNAS and PRKAR1A genes, and exons 2 and 3 of HRAS, KRAS and NRAS were amplified by PCR and sequenced. Previously unreported mutants were cloned in expression vectors and their basal constitutive activities were determined by quantification of cAMP response element (CRE)-luciferase activity in CO7 cells transfected with wild-type and mutant plasmids.ResultsTSHR gene mutations were found in 52 (61.2%) samples, GNAS gene mutations in 4 (4.71%) samples and no PRKAR1A or RAS mutations were found. Only three previously unreported mutations were found, two affecting the TSHR, A623F and I635V, and one affecting the G-protein α-subunit (Gsα), L203P. All mutant proteins showed higher CRE-luciferase activity than their wild-type counterparts.ConclusionsTA in a hyperthyroid population living in Galicia, a Spanish iodine-deficient region, harbours elevated frequencies of TSHR and GNAS mutations activating the cAMP pathway. However, the genetic cause of TA was undetermined in 34% of the TA samples.

Multivariate techniques have been applied to the set of data obtained after one year sampling of volatile organic compounds (VOCs), including volatile aldehydes in the area of Madrid in order to evaluate the possible correspondence among groups of analysed compounds, as far as modelling of different emission sources in relation to location and season. The measurements were carried out at four sites in Madrid, characteristic for urban and suburban areas. Additionally, as reference, a rural area 100 km far from the city was considered. Results of correlation analysis, factor and cluster analysis are presented. Higher correlations were found between variables related with traffic emissions. Factor analysis results showed two main significant variables related to anthropogenic and biogenic emissions respectively. In relation to cluster analysis, samples were grouped according to sampling site and seasonal variations.

13 páginas, ilustraciones y tablas estadísticas, En el presente estudio se ha evaluado la capacidad de absorción y acumulación de metales pesados (Pb, Cu, Ni, Zn y Cr) en parte aérea (tallos y hojas) y raíces de tres especies vegetales, Vicia sativa L. (veza), Hordeum vulgare (cebada) y Helianthus annuus L. (girasol), sembradas en suelos enmendados con lodos de depuradora en condiciones de invernadero. Se aplicaron lodos compostados con restos de poda a un suelo degradado de carácter básico procedente de un cultivo abandonado en la zona Centro de España (Alcalá de Henares) Se realizaron 3 tratamientos distintos para cada una de las especies ensayadas: Testigo (sin adición de lodo); Dosis baja-media de lodo (42,5 t/ha) y Dosis alta de lodo (85 t/ha) y 3 repeticiones por tratamiento. Se analizó el efecto de la dosis de lodo aplicada en la capacidad de acumulación de metales en distintas partes de la planta, con el fin de evaluar la absorción y traslocación de cada elemento. Este hecho podría limitar la aplicación de este tipo de enmiendas en suelos agrícolas. Del mismo modo se ha evaluado la posibilidad de uso de estas especies en procesos de fitoextracción. Las concentraciones totales de Cu, Zn, Cr y Pb en suelos incrementaron lineaimente con la dosis de lodo aplicada en los ensayos con las tres especias vegetales, no observándose el mismo efecto para el Ni. En todos los casos, los valores de metales en los suelos fueron menores que los límites establecidos en la legislación (Directiva 86/278/CEE). En el análisis de metales en planta se observó en la cebada un incremento lineal en el contenido de todos los metales (excepto el Zn) en la parte aérea con la aplicación de lodos, sin embargo este efecto no se produjo tan marcadamente en el girasol y ia veza aunque si aumentó el contenido de metales en las plantas cultivadas en suelos enmendados con lodos. El contenido de metales totales en el sistema radicular de la cebada incrementó con la dosis de lodo aplicada. Esta misma tendencia se produjo en la veza para el Pb, Cu y Zn, y en el girasol para el Cu. En general las cantidades de metales acumuladas en la planta fueron mayores en la cebada que en la veza y el girasol, siendo significativos los valores en el caso del Cu, Ni y Cr. Este hecho implica la necesidad del control de los contenidos en metales pesados en cereales para evitar su paso a la cadena alimentaria., CAO-03-MAD-01 (FEOGA) y REN02-02501 (MCYT)

Urachal anomalies are uncommon defects arising either by incomplete obliteration of the urachus during the foetal period or by its reopening after postnatal regression. Five anomalies have been described: congenital patent urachus, urachal cyst, umbilical-urachal sinus, vesico-urachal diverticulum, and alternating sinus. Only congenital patent urachus is present at childbirth. The other forms are usually acquired disorders. Nevertheless, they commonly appear in children, being less common in the adult. Colic-urachal fistulas are quite uncommon findings. Only three cases have been reported thus far. The aim of this study is to report the fourth case of sigmoid-urachal fistula, and the first one appearing without an urachal cyst.

Background Ankylosing spondylitis produces a progressive decrease in spinal mobility with the evolution of the disease. This decrease is due to inflammation and structural damage at radiological level that occurs in neck and spine. Several indices have been validated to quantify this grade of affectation. The most used index to assess structural damage is the mSASSS. This index is evaluated between 0 to 72 points and it measures equally the affectation grade of the neck and lower back. Recently a new index based on motion analysis has been defined wich produces accurate and objective information about mobility, the UCOASMI [1] index. For calculating this index, two cervical mobility and three lumbar mobility measures are used, so cervical UCOASMI and lumbar UCOASMI can be defined. With the evolution of the disease UCOASMI and mSASSS indexes increases with more structural damage and loss of mobility, but what is the relation between lumbar and cervical damage with the evolution of AS? Objectives To analyze the evolution of AS in terms of radiological damage and mobility at the cervical and lumbar area. Methods 76 patients diagnosed with AS (75% male, age 44.1±11.5 years, duration 13.6±9.4 years) were analyzed. A radiologist assessed radiographs for calculating mSASSS. At the Motion Analysis Laboratory of the Reina Sofia University Hospital, UCOTrack system was used to calculate UCOASMI index. For both indices, coefficient cervical/lumbar ratio was calculated to identify which part was more affected. Results Table shows affectation grade in mobility (UCOASMI) and radiographic damage (mSASSS) in total sample and grouped by gender, duration, and affectation grade in mobility. Differences between groups are also showed indicating whether these are statistically significant. Conclusions The relation between affectation of cervical and lumbar part seems to be balanced around 50% according to both structural damage and mobility. Mobility differences in genre were not appreciated. While there are differences in the structural damage between male and female, this difference appears similarly in both areas. According to our results, only at initial stages of the disease, lower back is most affected, especially as far as mobility is concerned. References Garrido-Castro JL, Escudero A, Medina-Carnicer R, Galisteo AM, Gonzalez-Navas C, Carmona L, Collantes-Estevez E. Validation of a new objective index to measure spinal mobility: the University of Cordoba Ankylosing Spondylitis Metrology Index (UCOASMI). Rheumatol Int. 2013 Dec 20. [Epub ahead of print] Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3280

Background Osteoarthritis of the knee (OA) is the most common disease affecting the musculoskeletal system and one of the most important causes of disability among elderly population. Patients are assessed by questionnaires whose response may be influenced to some subjectivity (WOMAC, VAS, SF36). Gait analysis and ground reaction forces (GRF) produce objective and quantitative results of patient status with well-defined patterns. Vertical force curves are characterized by showing two peaks and a valley, showing a graph like an inverted W. Intra-articular injections of hyaluronic acid for the treatment of knee OA have been shown to reduce pain and improve joint function. In this work we have used GRF as evaluation tool in patients with knee OA before and after applying intra-articular treatments. Objectives To analyze ground reaction forces in patients with knee OA before and after intraarticular treatment. Methods 26 patients with knee OA (57.68±8.06 years, 1.65±0.88 m, 87.74±13.06 kg) with a high level of affectation (grade II-III according to Kellgren and Lawrence scale) and 6 healthy subjects as control group with similar characteristics (55.33±5.07 years, 1.70±0.77 m,. 88.52±10.15 kg) were analyzed. Intraarticular injections of hyaluronic acid were applied to patients before and after measurements (one and three months). Vertical, mediolateral and anteroposterior GRF were evaluated using a triaxial force plate (Bertec ® FP4060) Results GRF in three axis and some temporary values as support time and first peak time in vertical force are showed in table. Significant differences between patients and control group in almost all parameters analyzed were found, showing a biomechanical altered gait. Regarding treatment sensitive measures, we could highlight first time peak in vertical force, force in the valley and difference between peak and valley. Sensitive measures also appear in the other two axis with larger braking and impulse forces. Also a shorter support time appears. Conclusions Our study shows that GRF clearly improved approximating to values obtained for control group after intraarticular treatment. The evaluation of GRF in gait could be used as an evaluation tool, not only to demonstrate the biomechanical alteration produced by knee OA, but also as a tool for evaluating the effectiveness of treatment. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3313

Consultation in Internal Medicine is a common task of the attending labor of the internist in a general hospital and is a relevant link for intrahospital cohesion. In the present work the characteristics of 738 consultations, which represented all consultation request forms received at our Department during a nine-month period, were studied. A 55.4 percentage of consultation forms were requested urgently and 93.6% of them were answered on the same day. Most consultation parts received came from General Surgery and traumatology, with a predominance of cardiologic, pneumologic, infectious and multiple causes. The assessment of the urgency made by the internist coincided with the urgent request only in 38.3% of cases. A clinical follow-up was made for 33.3% of patients and 2% of them were transferred to the Internal Medicine Department. The consultation was repeated for 22.5% of the total of patients. Only in 23.1% of cases an oral link with the referring physician occurred. To remark the relevance of the consultation for the optimization of care quality to our patients and its influence on the inter-relationship between specialists in different fields of medicine.

We studied interleukin 6 (IL-6) and soluble IL-6 receptor (sIL-6R) in serum and synovial fluid (SF) to investigate their role in different arthropathies.IL-6 was measured by ELISA and bioassay and sIL-6R by ELISA, in 210 sera and 73 SF samples from 49 patients with rheumatoid arthritis (RA), 20 crystal deposition disease, 17 osteoarthritis (OA), 24 with other inflammatory arthropathies, and 100 controls. In all patients, disease activity was assessed by erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); in patients with RA and other arthropathies pain, tender and swollen joints, and Ritchie index were also evaluated. Total leukocyte count in SF was determined.There was good correlation between IL-6 ELISA and bioassay levels both in serum (r = 0.62, p = 0.0001) and in SF (r = 0.72, p = 0.0001). Serum IL-6 was detected only in patients with inflammatory arthritis and SF IL-6 was detected in all patient groups. Serum IL-6 correlated with swollen joints (r = 0.35, p = 0.05), ESR (r = 0.46, p = 0.001), and CRP (r = 0.46, p = 0.001) in RA; and with CRP (r = 0.89, p = 0.0001) in crystal deposition disease. SF IL-6 correlated with ESR (r = 0.54, p = 0.007) and CRP (r = 0.42, p = 0.04) in RA; with SF total leukocyte count (r = 0.61, p = 0.004) in crystal deposition disease; and with SF total leukocyte count (r = 0.61, p = 0.009) in OA. No correlations were found in the group with other inflammatory diseases. No correlations were found between sIL-6R and IL-6 or between sIL-6R and disease activity variables in any group of patients.Unlike IL-6, sIL-6R is not produced at the site of inflammation and is not related to clinical or biological disease activity variables. Only in RA are both IL-6 and sIL-6R levels increased, suggesting that sIL-6R may reinforce the systemic effects of IL-6.

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease which causes a reduction in the patient mobility. Several studies show that, at radiological level, structural damage is much higher in men. There are few studies about gender differences in spinal mobility. Recently new technologies as motion capture have been introduced for assessing spinal mobility[1]. Objectives To analyze, using measures obtained by a motion capture system, gender differences in spinal mobility of patients with AS in the medium and long term. Methods 70 AS patients were analized (76.7% men). Two groups of patients were defined: medium and long term according disease duration (long term > 10 years). Cervical and spinal mobility were assessed using a motion capture system, the UCOTrack© [1]. Questionnaries about function and activity, conventional metrology (BASMI), and radiological scores (mSASSS) were also obtained. From motion capture several measurements were analyzed included a metrological index, the UCOASMI, based on motion capture measurements. Results No significant differences between men and women in self-rated questionnaires were found, although women obtain worse scores particularly in the medium term. Occiput-wall distance differences was found between sexes. Some measures obtained by the motion capture system were different between genders: UCOASMI, lateral spinal flexion and cervical flexion. Conclusions Results obtained by motion analysis corroborate similarities between genders as shown by several authors. Men have better mobility at medium term, inverting this difference at long term due mainly to structural damage. Motion capture provided additional accuracy information that can be useful in the diagnosis and therapeutic management of the disease. References Assessment of spinal mobility in ankylosing spondylitis using a video-based motion capture system. Garrido-Castro J.L, Medina-Carnicer R, Schiottis R., Galisteo A.M, Collantes E., Gonzalez-Navas C. Manual Therapy 2012 Oct;17(5):422-6. Disclosure of Interest None Declared

Background Knee osteoarthritis (OA) is the most common disease affecting human locomotion, and one of the most important causes of disability among the elderly population. In order to assess health status of patients self-evaluated questionnaires are commonly used, wich may be influenced by certain degree of subjectivity. Hialuronic acid is a common used treatment to improve knee OA. A force plate connected to a computer allows to analyze postural stability evaluating the center of pressure (CoP) sway in the lateral and sagittal planes. These methods of assessment the postural stability have shown excellent reliability in previous studies. Objectives Analyze the assessment of postural stability in patients with Knee OA using a triaxial force plate. Methods 10 patients with knee OA were analyzed (6 women and 4 men, age 55.3±3.2 years, weight 82.5±12.9 Kgr.) and 6 healthy subjects (4 women and 6 men, age 53.1±1.6 years, weight 78.3±10.4 Kgr.) as control group. Patients had a II-II degree of knee OA according to Kellgren and Lawrence scale. Hyaluronic acid injections were applied into the affected knee. Measures were taken before and after (4 weeks) treatment. A triaxial force plate (Bertec © FP5040) was used to assess postural balance. Patiens remained quiet for 10 seconds on the force plate, first with their eyes open (EO) and then another 10 seconds with their eyes closed (EC). Following parameters were recorded: total CoP distance, distance covered in antero-posterior and medio-lateral directions, area covered, and Romberg test (relation between EC and EO area). Patients fulfilled questionnaires in each test in order to calculate indexes: VAS general, VAS pain, WOMAC, SF-36 and OARSI criteria. Results Significant differences were observed in CoP area in both EO and EC, and in Romberg test, between pre and post treatment measures. Differences between control group and patients were significant in almost all parameters. In questionnaires based indexes, improvements were showed, although these differences were not statistically significant. Correlations were found between CoP sway with EC (p Conclusions Despite being a pilot study, with a very reduced sample, measurements of postural stability obtained from the force plate were sensitive to treatment. It was also interesting correlations between balance and pain level according to VAS, wich seems to show that pain in knee OA produces certain postural imbalance, as previous studies shown. Future studies with larger sample size may demonstrate our hypothesis, so this kind of technology can be used to assess outcome in knee OA patients and to show effectiveness treatments. Disclosure of Interest None Declared

We report the case of a 35-years-old-woman with history of abdominal surgery who presented several episodes of intermittent intestinal obstruction. Postoperative adhesions were suspected; laparoscopy surgery was made and uterine and anexial inflammation was observed. She was discharge with the diagnosis of inflammatory pelvic disease. Posteriorly, she was admitted with a new episode of intestinal obstruction. At laparotomy, intestinal intussusception was founded due to the presence of intestinal leiomyoma. We stress the relevance of two possible etiologies of intestinal obstruction; the coexistence of them difficult the diagnosis. Epidemiology, clinical presentation and diagnosis of leiomyomas of small intestine were reviewed.

Two-level pH monitoring was performed for 24 hours in 20 healthy subjects to document the presence of reflux episodes and to obtain reference values for reflux studies. The pH probes were placed 5 and 20 centimetres above the LES by means of a manometric technique. Significant differences were found at these two levels. At the proximal esophageal level 18 of the 20 subjects had reflux episodes. Five centrimetres above the lower esphageal sphincter the total reflux time was 1.35%, 2.05% in the upright and 0.15% in the supine positions. At 20 centimetres level it was significantly lower: 0.5% the total percent time with pH below 4, 0.8% and 0% in the upright and supine positions respectively. The mean reflux time was about 40% of the distal value, but the same pattern of reflux was observed at two levels of the esophagus. This technique is useful in documenting the cephalad extend of GER and allows to identify normal GER patterns at different levels of the esophagus.

During cocaine exposure, the liver undergoes significant morphological and biochemical changes. We report here changes in the ganglioside pattern of rat liver after repeated administration (over 5 hours, one injection per hour) of a moderate dose of cocaine (10 mg/kg body weight). Cocaine exposure results in an accumulation of more complex gangliosides (GM1, GD1a, GD1b, GT1b and GQ1b) and a reduction of precursors (GM3, GM2, GD3 and GD2). Our results suggest that ganglioside biosynthesis could be affected by an alteration of vesicular transport from cis- to trans-Golgi cisternae produced either by cocaine itself or by some product of cocaine metabolism.

Two seroepidemiological surveys carried out so far, one in Japan, the other in France, gave a strong indication that dogs may be naturally infected by influenza C virus, considered to be exclusively human until recently. In this work, 101 serum samples were collected during winter 1989/1990 from dogs in Castilla y León, Spain. Sera were tested for the presence of antibodies to influenza C virus by Hemagglutination Inhibition (HI) test. Using antibody absorption by staphylococcal protein A, we demonstrated the specificity of the results. Significant HI activity was found in 56.3% of the 101 tested sera and titres ranged from 25 to 200.

Thrombotic thrombocytopenic purpura (TTP) is a syndrome characterized by fever, microangiopathic hemolytic anemia, thrombocytopenia, renal disease and neurologic changes. The development of little thrombi in the systemic microcirculation is thought to play an important role, however the etiology is unknown. We present two cases in which pancreatic disease was the first manifestation of TTP.